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Survival After Curative Pelvic Exenteration for Primary or Recurrent Cervical Cancer: A Retrospective Multicentric Study of 167 Patients

Chiantera, Vito MD; Rossi, Martina MD*†; De Iaco, Pierandrea MD; Koehler, Christardt PhD*; Marnitz, Simone PhD; Ferrandina, Gabriella MD§; Legge, Francesco MD; Parazzini, Fabio MD; Scambia, Giovanni PhD§; Schneider, Achim PhD*; Vercellino, Giuseppe Filiberto MD*

International Journal of Gynecological Cancer: June 2014 - Volume 24 - Issue 5 - p 916–922
doi: 10.1097/IGC.0b013e3182a80aec
Cervical Cancer

Objective: Evaluate the survival of patients who underwent pelvic exenteration (PE) with curative intent for primary persistent or recurrent cervical cancer.

Methods: We retrospectively investigated 167 consecutive patients, referred to the gynecological oncology units of 4 centers in Germany or Italy, who underwent PE. Data regarding surgery, histology, and oncologic outcomes were collected and statistically evaluated. Survival was determined from the day of exenteration until last follow-up or death.

Results: The median age was 51 years. Twenty-seven patients (16.2%) underwent PE owing to advanced primary tumors (group A), 34 patients (20.4%) underwent PE owing to persistent cancer after chemotherapy or chemoradiation (group B), and 106 patients (63.4%) underwent PE owing to recurrence (group C). The prevalent histologic type was squamous cell cancer. A complete tumor resection (R0), was achieved in 121 patients (72.5%). Forty-nine patients (29.3%) had pelvic lymph node metastases and 44 patients (26.3%) had pelvic sidewall involvement. Overall survival at the end of the study was 40.7%. The cumulative 5-year overall survival for the entire cohort was 38%. Resection margins, pelvic lymph node state, and sidewall involvement were independent prognostic factors in multivariate analysis.

Conclusion: Pelvic exenteration is a valid therapeutic option for patients with locally advanced primary persistent or recurrent cervical cancer, with a long-term survival in 40% of the patients.

*Department of Gynecology and Gynecological Oncology, Campus Mitte (CCM) and Campus Benjamin Franklin (CBF), Charitè University Berlin, Berlin, Germany; †Gynecologic Oncology Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy; ‡Department of Radiooncology, Campus Mitte (CCM) and Campus Virchow (CVK), Charitè University Berlin, Berlin, Germany; §Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy; ∥Università di Milano, Fondazione Policlinico Milano, Milan, Italy; and ¶Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Campobasso, Italy.

Address correspondence and reprint requests to Vito Chiantera, MD, Department of Department of Gynecology and Gynecological Oncology, Charitè University, Hindenburgdamm 30, 12203 Berlin, Germany. E-mail: vito.chiantera@charite.de.

The authors declare no conflicts of interest.

Received June 7, 2013

Accepted August 4, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.